The October issue of the Archives of Disease in Childhood has new recommendations for general pediatricians and family physicians for diagnosing and managing infant cow’s milk protein allergy (CMPA).

Statistics indicate from 5 per cent to 15 per cent of infants have a reaction to cow’s milk protein, while true allergy estimates are between 2 per cent and 7.5 per cent. The wide range in numbers underscores the importance of good diagnoses, which will reduce the number of infants on unnecessary elimination diets. Researchers indicated that CMPA is easily missed in family medical practices and should be considered as an underlying cause of infant distress, as well as a host of other diverse physical symptoms.

CMPA is an immune system response to cow’s milk protein. This is different from lactose intolerance or other reactions to milk. Note that CMPA can develop even in fully breast-fed infants who may be exposed to milk proteins through their mother’s breast milk. CMPA may cause digestive symptoms including spitting up, vomiting and changes in bowel movements. However, there may also be skin rash, swelling and hives.

Recommendations from the study include:

1. Breast-feeding should be exclusive for at least the first 4 months. Breast fed babies have significantly lower incidence of CMPA. If a breast fed baby does develop symptoms of CMPA, the mother should start a diet which excludes cow’s milk, peanuts and hen’s eggs. This regimen should be continued for at least 2-4 weeks before deciding if the elimination diet is working.

2. If the baby’s symptoms improve after a mother has used an elimination diet, she can re-introduce foods at a rate of 1 per week. If symptoms re-develop, that food should be kept out of the diet.

3. If an elimination diet does not help with a breast-fed baby’s symptoms, a visit with a pediatric allergy specialist is warranted.

4. With formula-fed babies, a hypoallergenic formula should be introduced. The best choice is an amino-acid based formula, as other formulas may still provoke a reaction. Keep in mind that amino-acid baby formulas are expensive.

5. Note that skin prick tests and radioallergosorbent testing do not appear to prove or disprove the presence of CMPA at this age, so elimination protocols are the best bet for diagnosis.

6. Formula-fed children with suspected severe CMPA should be referred to a pediatric specialist and must be on amino-acid based baby formula.

Source: Medscape Today